Low serum amylase in association with metabolic syndrome and diabetes: A community-based study

<p>Abstract</p> <p>Background</p> <p>Low serum amylase levels may reflect impaired exocrine-endocrine relationship in the pancreas. However, few clinical studies have addressed this issue. Therefore, in this epidemiological study, we investigated whether low serum amylase was associated with the pathogenesis of impaired insulin action: metabolic syndrome (MetS) and diabetes.</p> <p>Research Design and Methods</p> <p>Serum amylase, cardiometabolic risk factors, MetS (Adult Treatment Panel III criteria), and diabetes were examined in 2,425 asymptomatic subjects aged 30-80 years who underwent medical checkups recently (April 2009-March 2010) and 5 years ago.</p> <p>Results</p> <p>Clinical variables, except for age and estimated glomerular filtration rate (eGFR), shifted favorably with increasing serum amylase levels. Plasma glucose levels at 1- and 2-hr during OGTT increased significantly with decreasing serum amylase levels. Multiple logistic analyses showed that, compared with highest quartile of serum amylase, lowest quartile was associated with increased risk for MetS and diabetes after adjustment for confounding factors [odds ratio (95% CI), 2.07 (1.39-3.07) and 2.76 (1.49-5.11), respectively]. In subjects who underwent checkups 5 years ago (n = 571), lower amylase at the previous checkup were associated with larger numbers of metabolic abnormalities at the recent checkup. The fluctuation over time in serum amylase levels in subjects with low serum amylase at the previous checkup was slight and was unaffected by kidney dysfunction.</p> <p>Conclusions</p> <p>Our results indicate that low serum amylase is associated with increased risk of metabolic abnormalities, MetS and diabetes. These results suggest a pancreatic exocrine-endocrine relationship in certain clinical conditions.</p

Asymptomatic trace and overt proteinuria in high- and lowbody weight individuals: A preliminary report of communitybased epidemiological study

Background: Overt proteinuria (OP), an established risk factor for kidney and cardiovascular disease, is much prevalent in high and low body weight individuals. Objectives: However, it is equivocal whether trace proteinuria (TrP) is also associated with high and low body weight. Therefore, we address this issue in a large epidemiological study. Patients and Methods: Regarding this association, we examined TrP defined as ± by dipstick urinalysis, in comparison with OP (≥+1) using the data of 70 886 apparently healthy Japanese men and women who underwent a checkup in 2008, aged 20-85 years old. Results: The prevalence of TrP, which was slightly but significantly higher (4.1%) on average compared with OP (3.1%), showed a J-shaped relationship against body mass index (BMI). Logistic regression analysis showed that compared to BMI of 21.0-22.9 kg/m2 , other BMI categories except BMI of 19.0–20.9 kg/m2 were significantly associated with TrP, which were not altered after adjustment for relevant confounding factors including age, sex, and pharmacotherapies for hypertension and diabetes. Unlike TrP, OP was not significantly associated with BMI of 23.0–24.9 kg/m2 , a high-normal body weight, although similar trends were observed in the overall relationship between BMI categories and OP. Conclusions: Current study suggests that TrP is also associated with high and low body weight, seemingly like OP. However, the degree and pattern of associations of TrP with BMI may differ from those of OP. Further study is required particularly in terms of fundamental clinical relevance of TrP

Effects of Weight Loss Speed on Kidney Function Differ Depending on Body Mass Index in Nondiabetic Healthy People: A Prospective Cohort.

Obesity is associated with diabetes mellitus and cardiovascular diseases. However, it has been reported that weight loss is associated with incident chronic kidney disease (CKD) in healthy males. The purpose of this prospective cohort study is to investigate the effects of weight loss on kidney function in healthy people in terms of body mass index (BMI) and gender.A total of 8447 nondiabetic healthy people were enrolled in the Saitama Cardiometabolic Disease and Organ Impairment Study, Japan. Relationships between estimated glomerular filtration rate (eGFR) change, BMI, and BMI change were evaluated using 3D-scatter plots with spline and generalized additive models (GAMs) adjusted for baseline characteristics.The subjects were stratified into four groups according to BMI. The mean±standard deviations for males and females were, respectively, 40.11±9.49, and 40.3±9.71 years for age and 76.39±17.72 and 71.49±18.4 ml/min/1.73m2 for eGFR. GAMs showed that a decreasing BMI change (<-1 kg/m2/year) was associated with a decreasing eGFR change in males with high normal BMIs (22 kg/m2≤BMI<25 kg/m2). A decreasing BMI change (<-2 kg/m2/year) was associated with an increasing eGFR change in overweight males (25 kg/m2≤BMI). Among underweight females (BMI<18.5 kg/m2), decreasing BMI was observed with decreasing eGFR.These findings suggest that the benefit and risk of weight loss in relation to kidney function differs depending on BMI and weight loss speed, especially in males

Uric acid level has a U-shaped association with loss of kidney function in healthy people: a prospective cohort study.

BACKGROUND:The relationship between hyperuricemia and chronic kidney disease (CKD) has been found in various observational studies. Although hypouricemia is associated with cardiovascular events, it has not been established as a risk factor for CKD. We investigated the relationship between serum uric acid level and the loss of kidney function and incident CKD in healthy people. MATERIALS AND METHODS:Healthy people were enrolled in this community-based prospective cohort study, the Saitama Cardiometabolic Disease and Organ Impairment Study, Japan. The analysis was conducted on 4188 subjects followed up for at least 3 years, 3102 for 6 years and 1052 for 9 years. Their data including glomerular filtration rate (eGFR) decline were examined every three years. The outcome event was incident CKD or the decrease in eGFR by more than 25% in three years. Multivariate statistical models were adjusted for the baseline characteristics. RESULTS:The following data was obtained: mean ± SD age, male, 39.6 ± 10.4 years, female 38.4 ± 10.8 years; eGFR, male, 81.9 ± 16.4 ml/min/1.73 m2, female, 82.1 ± 17.5 ml/min/1.73 m2; serum uric acid level, male, 5.8 ± 1.2 mg/dl, female, 4.1 ± 0.9 mg/dl. Both low and high serum uric acid levels were associated with the outcome and eGFR decline in males (multivariate logistic additional additive models, linear p = 0.0001, spline p = 0.043; generalized additive models, linear p = 0.0001, spline p = 0.012). In subjects with low serum uric acid levels (male, <5 mg/dl; female, <3.6 mg/dl), multivariate linear mixed models showed that low serum uric acid levels were associated with eGFR decline in a time-dependent manner (male, p = 0.0001; female, p = 0.045). CONCLUSION:This study showed that low as well as high levels of uric acid are associated with the loss of kidney function. Hypouricemia is a candidate predictor of kidney function decline in healthy people

Effects of exercise frequency on loss of kidney function.

<p>In males, frequent exercise was more associated with loss of kidney function than no exercise. Score 0 = twice a month or less; score 1 = once a week; score 2 = twice a week or more. Adjusted odds ratios are shown with 95% confidence intervals. The logistic regression models are adjusted for the baseline characteristics. *, <i>p</i><0.05. Abbreviations: aOR, adjusted odds ratio; Ref, reference.</p

Effect of BMI change on eGFR change in females of Group 1.

<p>The curve from a generalized additive model with spline shows the pattern of the effect of BMI change on eGFR change with 95% confidence interval. Positive and negative values of the effect indicate increasing and decreasing eGFR changes, respectively. The models were adjusted for baseline characteristics. Abbreviations: Effect, effect of BMI change on eGFR change; BMI, body mass index; eGFR, estimated glomerular filtration rate.</p

Effects of exercise frequency on loss of kidney function.

<p>In males, frequent exercise was more associated with loss of kidney function than no exercise. Score 0 = twice a month or less; score 1 = once a week; score 2 = twice a week or more. Adjusted odds ratios are shown with 95% confidence intervals. The logistic regression models are adjusted for the baseline characteristics. *, <i>p</i><0.05. Abbreviations: aOR, adjusted odds ratio; Ref, reference.</p

Baseline characteristics of gender-specific groups classified by body mass index in females.

<p>Female</p><p>Group 1 (underweight), BMI < 18.5 kg/m²; Group 2 (low normal BMI), 18.5 kg/m² ≤ BMI < 22 kg/m²; Group 3 (high normal BMI), 22 kg/m² ≤ BMI < 25 kg/m²; Group 4 (overweight), 25 kg/m² ≤ BMI. Values are presented as mean±SD.</p><p>Abbreviations: BMI, body mass index; eGFR, estimated glomerular filtration rate; hypertension, history of hypertension; dyslipidemia, history of dyslipidemia; CVD, history of cardiovascular disease; smoking, currently smoking.</p><p>Baseline characteristics of gender-specific groups classified by body mass index in females.</p

Effect of BMI change on eGFR change in males.

<p>The curve from a generalized additive model with spline shows the pattern of the effect of BMI change on eGFR change with 95% confidence interval. Positive and negative values of the effect indicate increasing and decreasing eGFR changes, respectively. The models were adjusted for baseline characteristics. Abbreviations: Effect, effect of BMI change on eGFR change; BMI, body mass index; eGFR, estimated glomerular filtration rate. A. Group 1 Linear <i>p</i> = 0.21, spline <i>p</i> = 0.18. B. Group 2 Linear <i>p</i> = 0.0001, spline <i>p</i> = 0.24. C. Group 3 Linear <i>p</i> = 0.0011, spline <i>p</i> = 0.0072. D. Group 4 Linear <i>p</i> = 0.0001, spline <i>p</i> = 0.0001.</p